Sex-based Analysis of Laparoscopic Cholecystectomy Outcomes: A Prospective Cohort Study

Background Sex-based differences in laparoscopic cholecystectomy (LC) outcomes remain poorly understood, with conflicting evidence regarding the effects of patient sex on surgical complexity and complications. This study aimed to comprehensively evaluate sex-based differences in laparoscopic cholecystectomy outcomes using rigorous statistical analysis. Methods This prospective cohort study was conducted at Al-Kuwait University Hospital, Yemen, between January 2023 and June 2024. After applying strict exclusion criteria, 218 patients were included: 175 females (80.3%) and 43 males (19.7%). Bivariate analysis, multivariate logistic regression, and enhanced analyses were used to examine the demographic characteristics, preoperative profiles, intraoperative findings, and postoperative outcomes. Results Males were significantly older (46.0 ± 15.3 vs 40.9 ± 11.8 years, p = 0.034) with a higher prevalence of diabetes (27.9% vs 8.6%, p = 0.001) and chronic liver disease (7.0% vs 0.6%, p = 0.025). Males more frequently presented with acute cholecystitis (55.8% vs. 35.4%, p = 0.005). The incidence of intraoperative complications, particularly gallbladder perforation (41.9% vs. 21.1%, p = 0.009), was significantly higher in men than in women (16.3% vs. 5.7%, p = 0.046). Males had longer hospital stays (2.7 ± 1.7 vs 2.4 ± 2.1 days, p = 0.021). Multivariate analysis identified acute cholecystitis as the strongest predictor of conversion to open surgery (OR 3.90, 95% CI: 1.95–7.80, p = 0.001). Conclusions This study demonstrated significant sex-based differences in the LC outcomes. Males present with more complex disease patterns, experience higher rates of intraoperative complications, and require longer hospital stays. These findings necessitate sex-specific considerations in preoperative counseling, surgical planning, and postoperative care protocols.